Itala Manosha Wickremasinghe, MD

Primary specialty

Spinal Cord Injury Medicine PhysicianTaxonomy code 2081P0004X

License

92490 Issued in CA

Practice address

4500 S Lancaster Rd
Dallas, TX 75216-7167

Phone

(214) 857-1757

NPI assigned

Aug 21, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508972050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8631 CLOVER MEADOW DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752437626",
            "telephone_number": "214-553-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 S LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752167167",
            "telephone_number": "214-857-1757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKREMASINGHE",
        "first_name": "ITALA",
        "middle_name": "MANOSHA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "CA",
            "license": "92490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prajnawati Wibowo, NP
• Sara B. Wick, GNP
• Gena Menzdorf Wickes, D.C.
• Jonathan Eric Wickiser, MD
• Lisa Baker Wicklund, LMFT-A
• Joyclyn T Wicks, M.D.
• Sarah Wicks, CAA
• Xaquita Wicks, FNP-C, MSN, BSN, RN
• Kristina Widjaja, PA-C
• Elizabeth Widtfeldt, LPC

• Spinal Cord Injury Medicine Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Spinal Cord Injury Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.